Frequently Asked Questions Is there someplace I can get help with drug bills for someone in my care? Who is eligible for PACE? • You must be 65 years of age or older. • You must be a Pennsylvania resident for at least 90 days prior to the date of application. • You cannot be enrolled in the Department of Human Services’ Medicaid prescription benefit. For a single person, total income must be $14,500 or less. For a married couple, combined income must be $17,700 or less. Prescriptions: Copay for generic drugs is $6; copay for single-source brand is $9. Who is eligible for PACENET? • You must be 65 years of age or older. • You must be a Pennsylvania resident for at least 90 days prior to the date of application. • You cannot be enrolled in the Department of Human Services’ Medicaid prescription benefit. PACENET income limits are slightly higher than those for PACE. For a single person, total income can be between $14,500 and $33,500. For a married couple, combined total income can be between $17,700 and $41,500. Prescriptions: Copay for generic drugs is $8; copay for single-source brand is $15. Call your local Area Agency on Aging office for forms or for more information or go to https://pacecares.magellanhealth. com. Effective Jan. 1, 2022, PACENET cardholders not enrolled in a Part D plan will pay a $40.74 premium at the pharmacy each month they use their PACENET benefit. Income qualification is based on prior year’s income and includes taxable and nontaxable sources. Assets and resources are not counted as income. – Pennsylvania Department of Aging 16
What is the Medicare Savings Program (MSP)? The Medicare Savings Program helps pay for Medicare premiums. In some cases, the Medicare Savings Program may pay Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance, and copayments if a beneficiary meets certain conditions. QMB, SLMB, and QI are part of the program. Qualified Medicare Beneficiary (QMB): The income limit is $1,153 a month if single and $1,546 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if a beneficiary owes them – it also pays their Part A premiums. Specified Low-Income Medicare Beneficiary (SLMB): The income limit is from QMB levels up to $1,379 a month if single and $1,851 a month if married. SLMB pays for Part B premiums. Qualified Individuals (QI): The income limit is from SLMB levels up to $1,549 a month if single and $2,080 a month if married. QI pays for Part B premiums. Provides financial assistance with Medicare Part D prescription drug coverage (monthly premiums, deductibles, and drug costs). MSP asset limits: The asset limits for QMB, SLMB, and QI are $8,400 if single and $12,600. For information, call (800) 633-4227. – Medicare.gov What is the Medicaid spend-down program for regular Medicaid for the aged, blind, and disabled benefits and LTSS? Individuals with incomes too high to qualify for Medicaid for the aged, blind, and disabled can enroll in Pennsylvania’s Medicaid spend-down. This program allows applicants to qualify for Medicaid by subtracting medical and long-term care expenses. When an applicant enrolls in the Medicaid spend-down, the state determines the amount of their income that is above the income limit; this is
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known as “excess income.” Enrollees activate their coverage by submitting medical bills equal to this amount. Pennsylvania usually approves spenddown benefits in six-month increments, with additional coverage requiring new medical expenses be submitted. In Pennsylvania, the Medicaid spenddown program covers long-term services and supports. Income eligibility: The income limit is $425 a month if single and $442 a month if married. Asset limits: The asset limit is $2,400 if single and $3,200 if married. For information, call (866) 550-4355. – American Council On Aging What are Medicare Preventive Services? Early detection and treatment of health conditions can help reduce medical costs and maintain health. Many preventive care services are covered at a low or no cost. Talk to your doctor about preventive services available to you through Medicare. What is the Extra Help Program? Extra Help is a federal program that helps pay for prescription costs, premiums, deductibles, and coinsurance of Medicare prescription drug coverage for qualified beneficiaries. It is also known as the Part D Low-Income Subsidy (LIS). Persons may become eligible if certain requirements are met: • You have Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance). • You live in one of the 50 states or the District of Columbia. • Your resources (excluding your primary residence) are not worth more than $29,520 if you are married and living with your spouse or $14,790 if you are not currently married or not living with your spouse. (Do not count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial www.BusinessWomanPA.com
